<layout name='layout/main' />

<header class="am-header am-header-default">
	<div class="am-header-left am-header-nav">
	<a href="<{:U('Index/index')}>"><i class="am-header-icon am-icon-home"></i></a>
	</div>
	<h1 class="am-header-title">填写中奖信息</h1>
	<div class="am-header-right am-header-nav">
	<a href="javascript:window.history.go(-1)"><i class="am-header-icon am-icon-reply"></i></a>
	</div>
</header>

<form action="<{:U('Lottery/address')}>" method="post" class="ajax am-form address-form" id="doc-vld-msg">
	<div class="am-form-group">
        <p><{$list.event}></p>
    </div>


    <div class="am-form-group">
        <label>姓名</label>
        <input type="text" name="name" id="name" class="am-input-sm" placeholder="您的姓名" value="<{$address['name']}>" required/>
    </div>

    <div class="am-form-group">
        <label>手机号码</label>
        <input type="text" name="mobile" id="mobile" class="js-pattern-mobile am-input-sm" placeholder="请输入手机号码" value="<{$address['mobile']}>" required/>
    </div>

    <div class="am-form-group">
        <label>收件地址</label>
        <input type="text" name="address" id="address" class="am-input-sm" value="<{$address['address']}>" placeholder="邮寄奖品的收件地址" required/>
    </div>    

	<p><button class="am-btn am-btn-danger am-btn-block">提交</button></p>
    <input type="hidden" name="id" value="<{$list['id']}>">
</form>

<div class="footerBox"> <include file="Public:menu_member" /></div>